|
所属 |
医学部 附属病院 肝胆膵外科 |
|
職名 |
准教授 |
|
外部リンク |
|
|
関連SDGs |
|
論文 【 表示 ／ 非表示 】
-
Imamura N., Nanashima A., Tsuchimochi Y., Hamada T., Kawakami H., Hiyoshi M.
Gland Surgery 14 ( 4 ) 714 - 725 2025年4月
担当区分：筆頭著者, 責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Gland Surgery
Background: Neoadjuvant chemotherapy (NAC) has been increasingly used in recent years in patients with pancreatic ductal adenocarcinoma (PDAC). This has forced a change in the practice of preoperative biliary drainage (PBD) is performed in PDAC patients scheduled for pancreatoduodenectomy (PD). What has changed in the NAC era and what is the appropriate method of PBD? To address this question, this study retrospectively reviewed the surgical outcomes and details of PBD in NAC and upfront surgery (US) patients. Methods: The study included consecutive PDAC patients who underwent PD from 2013 to 2021 during the transition from US to NAC, when outcomes were comparable. Clinical factors such as patient background, preoperative examination, surgical procedure, and postoperative complications were compared between the NAC group (40 patients) and the US group (59 patients), and details of PBD such as PBD procedure and adverse events were compared between the NAC and US groups who received PBD (27 NAC patients, 33 US patients). In the comparison test between groups, Fisher’s exact test and Mann-Whitney U test were mainly used. In addition, the outcomes and patency periods of each of the 128 PBD procedures were examined for the 60 patients who underwent PBD. The log-rank test was performed using the Kaplan-Meier method to compare patency period by PBD procedure. Results: There were no differences in patient background between the NAC and US groups. Compared with the US group, the NAC group had higher preoperative albumin (ALB) levels and less blood loss, but there was no difference of postoperative complications (NAC vs. US, 35% vs. 46%, respectively, P=0.29). With respect to PBD, the NAC group had more initial metallic stent (MS) placement (NAC vs. US, 52% vs. 15%, respectively, P=0.009), and fewer PBD-related adverse events (NAC vs. US, 33% vs. 61%, respectively, P=0.04). In a comparison of outcomes by drainage method, the duration of patency was significantly longer with MS placement than plastic stent (PS) placement (median days of patency, MS vs. PS, 68 vs. 15 days, respectively, P<0.001). However, MS placement and PS placement were equally likely to require a delay in the surgical schedule due to PBD-related adverse events (MS vs. PS, 6% vs. 6%, respectively, P>0.99). Conclusions: Prolonged PBD with NAC did not adversely affect surgical outcomes. MS placement provides a long patency period and is currently useful in PBD for PDAC patients undergoing PD after NAC, which requires a prolonged preoperative period. However, MS placement also has adverse events, and further studies are needed.
DOI： 10.21037/gs-2024-507
-
Nanashima A., Arai J., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ochiai T., Kawakami H., Sato Y., Takashi W.
Turkish Journal of Surgery 41 ( 1 ) 5 - 18 2025年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Turkish Journal of Surgery
Objective: To elucidate surgical strategies for patients undergoing radical resection, in cases where solitary distant lymph node metastasis is identified intraoperatively, we investigated the prognostic significance of para-aortic lymph node (PALN) metastases and other regional lymph node (RLN) metastases in pancreatic carcinomas (PC) and biliary duct cancers (BDC). Material and Methods: This study retrospectively analyzed data from 181 PC patients and 116 BDC patients who underwent radical resections at two institutions between 1994 and 2021. Results: Among PC patients, metastases were observed in RLN and PALN in 54% and 9% of cases, respectively. Similarly, RLN and PALN metastases were present among BDC patients in 39% and 9% of cases, respectively. Survival analysis revealed that patients with BDC and PALN metastases exhibited significantly reduced disease-free (DFS) and overall survival (OS) compared to those without PALN involvement. Multivariate analysis identified PALN metastasis as an independent predictor of OS in BDC patients (p<0.05), while RLN metastasis was independently associated with DFS (p<0.05). Additional clinicopathological factors associated with PALN and RLN metastases were also identified. Preoperative serum levels of Duke Pancreas II monoclonal antibody were significantly elevated in patients with PALN metastases. Histological findings of lymphatic or perineural infiltration and hepatic or pancreatic invasion were independently associated with RLN metastases. Conclusion: Based on these findings, radical resection may be considered for PC patients with isolated PALN metastases only in the absence of additional adverse prognostic factors. Prospective clinical trials are warranted to further refine the criteria for surgical intervention when solitary PALN metastases are detected intraoperatively.
-
Nanashima A., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ochiai T., Ichihara A., Hamada K., Ichiki N., Kai K., Higuchi K.
Translational Cancer Research 14 ( 1 ) 461 - 472 2025年1月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Translational Cancer Research
Background: Progression of chronic liver dysfunction influenced by long-term chemotherapy or repeated hepatectomy might be related to patient overall survival as well as tumor factors in colorectal liver metastasis (CLM) patients. Our aim of this study was to clarify the relationship between fibrotic liver damage and malignant behaviors of CLM malignancy or its long-term survivals by the retrospective cohort study. Methods: We examined the relationship between tumor-related factors or six liver fibrosis-associated parameters, including platelet count, hyaluronic acid (HA), mac-2 binding protein glycosylation isomer (M2BPGi), type IV collagen 7S (T4C7), aspartate aminotransferase-to-platelet ratio index (APRI), The fibrosis-4 (Fib-4) index, and clinicopathological parameters, surgical records, and postoperative patient survival in the 45 consecutive patients with CLM who underwent radical hepatectomy. Results: Fibrotic parameters were platelet count of 23.0±8.5 ×104/μL, HA level of 68.9±82.3 ng/mL, M2BPGi of 0.87±0.48 ng/mL, and type IV collagen level of 5.74±3.76 ng/mL. Platelet count was significantly correlated with HA level (P<0.05) and tended to be correlated with M2BPGi levels (P=0.056). HA level was significantly associated with albumin level (P<0.05). Overall survival in this series showed five-year overall survivors after hepatectomy in 44 patients (98%), but cancer-related deaths were observed in only one patient. Patients with higher grades and increased bilirubin levels demonstrated significantly lower cancer-free survival (P<0.05), but fibrotic parameters were not associated with prognostic factors. Conclusions: Fibrotic markers indicating chemotherapy or repeated surgical liver injury were not significant predictive factors reflecting cancer malignant behaviors or patient overall survival, contrary to our hypothesis. The current overall survival status using various modalities for cancer recurrence is satisfactory under our present perioperative management.
DOI： 10.21037/tcr-24-1138
-
Nanashima A., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Wada T., Shimizu I., Ochiai T.
Turkish Journal of Surgery 40 ( 4 ) 283 - 295 2024年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Turkish Journal of Surgery
Objective: We examined the relation between several fibrotic markers reflecting liver parenchymal injury and conventional liver function or surgical outcomes in 67 patients with cholangiocarcinoma who underwent biliary drainage for obstructive jaundice followed by surgical resection. Material and Methods: We examined conventional clinicopathological factors, six hepatic fibrosis parameters, including platelet count, hyaluronic acid, Mac-2 binding protein glycosylation isomer (M2BPGi), type IV collagen 7S, aspartate aminotransferase-to-platelet ratio index (APRI), and FIB-4 index before hepatectomy, and surgical outcomes or long-term prognosis. Results: Obstructive jaundice was observed in 57% of the patients, a history of biliary diseases in 7.5%, and chronic hepatic injuries in 17.9%. M2BPGi was significantly higher in patients with obstructive jaundice as the primary sign (p< 0.05), the FIB-4 index was significantly correlated with patient age (p< 0.01), and serum hyaluronic acid and T4C7 levels were significantly increased in distal cholangiocarcinoma (CC). No markers were associated with the histological hepatic fibrotic index, tumor-related factors, or postoperative morbidities. Tumor relapse was observed in 37% of patients, and cancer-related death was observed in 25%. A higher FIB-4 index was significantly associated with shorter cancer-free survival (p< 0.05). Cox multivariate analysis showed that bilirubin levels, poor histological cancer differentiation, and absence of fibrotic markers were associated with cancer-free, cancer-specific overall, and overall survival. Conclusion: Although a sufficient relation exists between these markers and elastographic or histological fibrotic indexes, the clinical significance of measuring conventional fibrotic markers might no longer be necessary in future studies.
-
Hosokawa A., Tamura H., Ichihara A., Imamura N., Kai K., Fukushima T., Nanashima A., Komohara Y.
Anticancer Research 44 ( 9 ) 4119 - 4125 2024年9月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Anticancer Research
Background/Aim: Immune checkpoint inhibitors are effective in treating microsatellite instability-high (MSI-H) metastatic colorectal cancer (CRC). Pathological complete response to immune checkpoint inhibitors for MSI-H metastatic CRC have been described in several reports. Liver metastasis is known to predict resistance to ani-programmed death 1 (PD-1)/PD-1 ligand 1 (PD-L1) therapy in several cancers, including CRC. Case Report: Herein, we report the case of a 23-year-old man with MSI-H colorectal liver metastasis who exhibited a pathological complete response to pembrolizumab following systemic chemotherapies. Pathological examination of the primary lesion revealed strong HLA-class I and HLA-DR expression in cancer cells. Elevated PD-L1 expression was observed in areas of increased CD8-postive T cell infiltration. Additional pathological study of regional lymph nodes showed increased PD-L1 and CD169 expression. Conclusion: A detailed pathological examination revealed PD-L1 expression not only in the primary CRC lesion but also in regional lymph nodes. Recent studies have highlighted the significance of regional lymph nodes in anti-cancer immune responses. Therefore, pathological studies using resected lymph nodes might be beneficial for predicting the response of anti-PD-1/PD-L1 therapy.
MISC 【 表示 ／ 非表示 】
-
Rare resected eight cases of duodenal adenocarcinomas
Nanashima A., Tanoue Y., Imamura N., Hiyoshi M., Yano K., Hamada T., Nishida T., Kai K., Suzuki Y., Sato Y., Nakashima K., Hosokawa A., Nagayasu T.
International Journal of Surgery Case Reports 86 106384 2021年9月
記述言語：日本語 掲載種別：速報，短報，研究ノート等（学術雑誌） 出版者・発行元：International Journal of Surgery Case Reports
Introduction: Duodenal adenocarcinoma is a rare malignancy; recently, it has been found to be accompanied by operative indications. Methods: Nine consecutive rare cases were diagnosed with duodenal carcinoma (DC), in which clinicopathological characteristics were retrospectively examined. Age was ranged over middle-aged males and females. No clinical onset with severe symptoms was observed, and the specific treatment for accompanied diseases or habits was not found. Outcomes: One case of two T1 stage DCs that underwent pancreas-sparing duodenectomy. Stage II DC was diagnosed in three cases, and stage III DC was diagnosed in four cases. Pancreaticoduodenectomy (PD) mainly occurred in seven patients, and duodenectomy was limited in two patients. All operations were safely performed, and the postoperative course showed no severe morbidity. Histological findings showed R0 resection in eight cases and R1 at the retroperitoneal dissecting part in one case. Five patients with advanced-stage DC underwent adjuvant chemotherapy; however, four patients showed tumor recurrence within 12 months. With additional strong chemotherapy, eight patients survived up to 84 months, and one died of liver metastasis at 43 months after surgery. Three representative cases of mucosal invasion with widespread pancreas-sparing duodenectomy and advanced-stage DC cases undergoing duodenectomy or PD are shown. Conclusion: In the field of upper digestive tract surgery, duodenal adenocarcinoma and various applications of surgery or adjuvant chemotherapy for long-term survival are important.
-
胆管内腔発育型腫瘍の概念と実態：表層進展型胆道系腫瘍． 招待あり 査読あり
濵田剛臣，矢野公一，今村直哉，旭吉雅秀，藤井義郎，七島篤志
肝胆膵 75 ( 6 ) 1151 - 1158 2017年12月
記述言語：日本語 掲載種別：記事・総説・解説・論説等（学術雑誌）
-
十二指腸乳頭部癌−現状の問題点と今後の展望−：経十二指腸的乳頭部切除の手技と適応． 招待あり 査読あり
今村直哉，七島篤志，濵田剛臣，矢野公一，旭吉雅秀，藤井義郎，武野慎祐，池田拓人，河野文彰，久保田良政，坂 哲臣，河上 洋
胆と膵 38 ( 7 ) 691 - 696 2017年7月
記述言語：日本語 掲載種別：記事・総説・解説・論説等（学術雑誌）
-
胆膵内視鏡自由自在〜基本手技を学び応用力をつける集中講座〜：ERCP関連手技編 乳頭処置 Bridge to Surgery 悪性肝門部領域胆管閉塞． 招待あり 査読あり
河上 洋，久保田良政，今村直哉，旭吉雅秀，藤井義郎，七島篤志
胆と膵 37 ( (臨増特大) ) 1279 - 1285 2016年11月
記述言語：日本語 掲載種別：記事・総説・解説・論説等（学術雑誌）
-
新たに定義された“肝門部領域胆管癌”の診断と治療: 術前胆道ドレナージ-経皮経肝胆道ドレナージ-. (共著)
藤井義郎，濱田朗子，西田卓弘，土持有貴，濱田剛臣，矢野公一，今村直哉，土屋和代，河野文彰，旭吉雅秀，大内田次郎，池田拓人，七島篤志
胆と膵 37 ( 1 ) 71 - 74 2016年1月
記述言語：日本語 掲載種別：記事・総説・解説・論説等（学術雑誌） 出版者・発行元：医学図書出版(株)
講演・口頭発表等 【 表示 ／ 非表示 】
-
転移性肝腫瘍に対する腹腔鏡下肝切除術の周術期成績の検討.
濵田剛臣，矢野公一，土持有貴，今村直哉，旭吉雅秀，七島篤志
第30回日本内視鏡外科学会総会 (京都) 日本内視鏡外科学会
開催年月日： 2017年12月7日 - 2017年12月9日
記述言語：日本語 会議種別：ポスター発表
開催地：京都
-
臨床外科学会 国内外科研修報告報告.金属アレルギーを有する患者の内視鏡外科手術について．
今村直哉，七島篤志，濵田剛臣，矢野公一，旭吉雅秀，藤井義郎
第9回膵臓内視鏡外科研究会 (京都) 膵臓内視鏡外科研究会
開催年月日： 2017年12月6日
記述言語：日本語 会議種別：口頭発表（一般）
開催地：京都
-
新規約におけるBorderline resectable膵癌の治療成績の再検討.
今村直哉，七島篤志，池ノ上実，和田 敬，濵田剛臣，矢野公一，旭吉雅秀，藤井義郎
第79回日本臨床外科学会総会 (東京) 日本臨床外科学会
開催年月日： 2017年11月23日 - 2017年11月25日
記述言語：日本語 会議種別：口頭発表（一般）
開催地：東京
-
EUS-FNAが術前診断に有用であった嚢胞性変化を伴う膵腺房細胞癌の１切除例.
池ノ上実，清水一晃，緒方祥吾，和田 敬，濵田剛臣，矢野公一，今村直哉，旭吉雅秀，藤井義郎，田中弘之，秋山 裕，片岡寛章，七島篤志
第79回日本臨床外科学会総会 (東京) 日本臨床外科学会
開催年月日： 2017年11月23日 - 2017年11月25日
記述言語：日本語 会議種別：ポスター発表
開催地：東京
-
シンポジウム1 外科と病理の協調 病理医は外科医からの疑問にどう応えるか：胆管内乳頭状腫瘍（IPNB）の胆道腫瘍における位置づけ.
七島篤志，今村直哉，佐藤勇一郎，角田順久，旭吉雅秀，藤井義郎
第22回日本外科病理学会学術集会 (栃木) 日本外科病理学会
開催年月日： 2017年11月10日 - 2017年11月11日
記述言語：日本語 会議種別：シンポジウム・ワークショップ パネル（公募）
開催地：栃木